跨关节钢板联合克氏针弹性固定治疗Myerson B型Lisfranc损伤

Dorsal bridge plating combined with Kirschner wire elastic fixation for Myerson type B Lisfranc injury

目的 探讨跨关节钢板联合克氏针弹性固定治疗Myerson B型Lisfranc损伤的疗效。方法 收集2018年6月至2020年12月在上海市宝山区罗店医院骨科和海军军医大学(第二军医大学)第一附属医院创伤骨科接受手术治疗的16例Lisfranc损伤患者的临床资料。其中男10例、女6例,年龄为(44.5±12.1)岁(25~65岁),左足损伤9例、右足损伤7例,从受伤到手术的时间为(7.5±1.7)d(5~11 d),Myerson分型均为B型。患者术中采用跨关节钢板固定第二跗跖关节,修复跗跖背侧韧带,并使用克氏针弹性固定内、外侧柱。术后观察切口愈合情况,记录并发症发生情况。末次随访时,采用美国矫形外科足踝协会踝-后足功能量表(AOFAS-AHS)和视觉模拟量表(VAS)评估功能疗效和疼痛情况。结果 16例患者术后均获得随访,随访时间为(17.2±2.2)个月(12~20个月);手术切口均为Ⅰ期愈合,未发生手术切口感染、皮肤软组织坏死、骨筋膜室综合征、腓深神经损伤、下肢深静脉血栓、克氏针松动、内固定失效、创伤性关节炎等并发症。末次随访时患足AOFAS-AHS评分为(86.3±3.4)分(70~95分),其中优10例、良4例、中2例,优良率为87.5%(14/16);VAS评分为(1.7±0.9)分(1~4分)。结论 对于Myerson B型Lisfranc损伤患者,采用跨关节钢板坚强固定第二跗跖关节、修复跗跖背侧韧带联合克氏针弹性固定内、外侧柱治疗可获得满意的临床效果。

Objective To evaluate the effectiveness of dorsal bridge plating combined with Kirschner wire elastic fixation in the treatment of Myerson type B Lisfranc injury.Methods The clinical data of 16 patients with Lisfranc injury who underwent surgical treatment in Department of Orthopaedics,Baoshan Luodian Hospital and Department of Orthopaedics Trauma,The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from Jun.2018 to Dec.2020 were collected.There were 10 males and 6 females with an average age of(44.5±12.1)years(range 25-65 years).There were 9 cases of left foot injury and 7 cases of right foot injury.The time from injury to operation was(7.5±1.7)d(range 5-11 d).According to the Myerson classification,all cases were type B.The second tarsometatarsal joint was fixed with dorsal bridge plating,and the dorsal ligament was also repaired.Furthermore,the medial and lateral columns were fixed with Kirschner wire.The wound healing was observed and the complications were recorded.At the final follow-up,the effectiveness and function were assessed by American Orthopaedic Foot and Ankle Society ankle-hindfoot scale(AOFAS-AHS),and the pain condition was assessed by visual analogue scale(VAS).Results All patients were followed for up 12-20 months,with an average of(17.2±2.2)months.All the incisions healed by the first intention.No incision infection,skin necrosis,osteofascial compartment syndrome,deep peroneal nerve injury,lower extremity deep venous thrombosis,Kirschner wire migration,internal fixation failure or traumatic osteoarthritis were observed in any patients.At the last follow-up,the AOFAS-AHS score was 86.3±3.4(range 70-95),including excellent in 10 cases,good in 4 cases,and fair in 2 cases,with an excellent and good rate of 87.5%(14/16);the VAS score was 1.7±0.9(range 1-4).Conclusion For patients with Myerson type B Lisfranc injury,the treatment of rigid fixation of the second tarsometatarsal joint with dorsal bridge plating,repair of the dorsal ligament,and elastic fixation of the medial and lateral columns with Kirschner wire can obtain satisfactory clinical results.